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RAISING PAIN AWARENESS
Easing Your
Patients’ Pain
An overview of pain, treatment options,
and the physicians who specialize in
treating pain
RAISING PAIN AWARENESS
ANS has partnered with the National
Pain Foundation (NPF), a non-profit
organization founded to advance
functional recovery of pain patients, to
create this educational presentation.
RAISING PAIN AWARENESS
Long-term pain affects most of your patients.
 3 out of 4 Americans have experienced chronic or
recurring pain or have a family member who has
experienced such pain.1
 Almost 62% of pain sufferers have had their pain
for a year or more.1
 A majority of adults (57%) have experienced
chronic or recurring pain, including 54% of adults
aged 18–34.1
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Topics included in this presentation
 Recognition of pain as a major health issue in the
United States
 Pain management as a medical specialty
 Advanced treatments for pain
 Referrals to interventional pain physicians
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Pain in the United States
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Types and definitions of pain
 Acute Pain
Accompanies tissue injury or pathology
Comes on quickly but lasts a short time
Varies in severity and intensity
 Chronic Pain
Continues a month or more beyond usual recovery period
Goes on for months or years due to a chronic condition
Difficult to define onset
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Types and definitions of pain
 Nociceptive Pain
Caused by irritation to special nerve endings
(nociceptors)
Can be dull or sharp
Can be mild or severe
 Neuropathic Pain
Caused by a malfunction of the nervous system
Result of injury, disease, or trauma
Can be sharp, intense, and constant
Can be dull, aching, and throbbing
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Millions of Americans suffer with pain…
 50 million Americans are partially or totally
disabled by chronic pain.2
 9 out of 10 Americans (aged 18 and older) suffer
with pain at least once a month.2
 77% of pain patients strongly agree that new
options are needed to treat their pain7
 50% of Americans (aged 65 and older) suffer with
pain on a daily basis.2
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…and chronic pain is a costly problem.
36 million per year miss work due to pain.2
Pain costs almost $100 billion annually.3
Pain results in over 50 million lost workdays.3
50% of chronic pain patients have lost a job due to
their illness7
 Workers lose an average of 4.6 hours per week of
productive time due to a pain condition.4
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Chronic pain is associated with many conditions.5
75%
40%
26%
26%
12%
Lower Back
Headaches
Pain
Osteoarthritis
Fibromyalgia
Migraines
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Pain management as
a medical specialty
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Interventional pain management medicine
 Growing as a new specialty
 Includes evaluation and treatment of acute and/or
chronic pain
 Requires that pain physicians receive at least one
year of training in pain management post medical
degree
 Requires knowledge of all of chronic pain therapy
options
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Pain assessment process
Physicians should address
 Types of pain
 Distribution of pain
 Patient’s current pain state
 Effects of patient’s current treatment
 Appropriate tools available for pain evaluation
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Treatment steps to consider
 Focus early treatment on quickly reversing the
problem.
 Identify the best methods of treatment.
 Define distinct goals for the patient.
 Pain reduction
 Improved function
 Enhanced quality of life
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Physicians who often specialize in pain management
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Anesthesiologist
Neurosurgeon
Neurologist
Orthopedic surgeon
Physiatrist (PM&R)
Rheumatologist
Other pain practitioners
 Acupuncturist
 Chiropractor
 Physical therapist
 Psychiatrist, psychologist,
or professional counselor
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Challenges facing pain physicians
 Managing the patient’s pain when a cure does
not exist
 Identifying ways to manage pain by using a
chronic pain treatment continuum
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Treatments early in the continuum
 Medications
 Physical therapy
 Counseling
This presentation will focus on the more advanced
treatments used by pain physicians.
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Advanced treatments for pain
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Advanced treatments: Injections
Nerve blocks—An
injection of local
anesthetic and/or
steroids that is
applied directly to
the nerve that serves
an area of pain
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Advanced treatments: Injections
Epidural steroid
injections—An
injection of
steroids into the
epidural space to
alleviate chronic
pain in the low
back or leg
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Advanced treatments: Injections
Facet joint
injections—An
injection procedure
used to block or
decrease pain that
originates in the
spinal facet joints
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Advanced treatments: Medical devices
Neurostimulators—
Implantable
devices that use
low-level electrical
impulses to
interfere with the
transmission of
pain signals to the
brain
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An overview of neuromodulation
 A system typically consist of three
components designed to work together
 Leads—very thin cables that deliver
electrical impulses to nerves near
the spinal cord
 Generator—the part of the system
that sends electrical energy through
the lead
 Controller—the device that
determines the level of stimulation
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SCS patient selection process
 Correctly diagnosed
 Failed lower-level therapies
 Successfully passed psychological
evaluation
 Patient is motivated
 Patient is educated
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SCS trial overview
 Leads are implanted in the epidural space
 An external power source is used to evaluate
 Pain relief
 Paresthesia coverage
 Power requirements
 Programming needs
 System requirements
 Patients can use the programmer to control
stimulation to cover their pain areas
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Why use spinal cord stimulation (SCS)?
 Effective pain management method
 Minimally invasive procedure that can be reversed
 Possible reduction or elimination of pain
medications
 International recognition and use
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Advanced treatments: Medications
Systemic opioids—Narcotics are used for patients
with severe chronic pain who have not responded
to more conservative therapies and for whom
surgery has failed or is not an option.
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Advanced treatments: Ablative procedures
 Cryoanalgesia—Applying extreme cold to nerves
to disrupt their ability to transmit pain
 RF lesioning—Applying radio-frequency generated
heat to nerves to disrupt pain transmission
 IntraDiscal Electrothermal Therapy (IDET)—
Applying heat to seal cracks and fissures in a
dehydrated disc
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Advanced treatments: Medical devices
Implantable drug
pumps—Devices
that deliver
medications
directly to the
cerebrospinal fluid
in the intrathecal
space surrounding
the spinal cord
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Advanced treatments: Surgery
Neuroablation—
Surgery that
permanently blocks
chronic pain by
destroying nerves
and tissues near the
source of pain
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Referring patients to pain physicians
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Pain patients often need specialized care.
 Pain accounts for 80% of all physician visits.2
 Only 48% of pain patients felt they were getting
enough information on the most effective ways to
manage chronic pain.7
 86% of chronic pain sufferers report an inability to
sleep well.7
 60% of pain patients experience breakthrough pain
one or more times daily.7
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Pain patients often need specialized care.
 14% of pain sufferers say that they are satisfied
with their current medications.7
 22% of chronic pain patients have changed
physicians 3 or more times.6
 The main reasons for changing physicians have to
do with the physicians’ attitudes, knowledge, and
abilities.6
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Pain physicians can help patients with
 Chronic back, neck, and shoulder pain
 Chronic headaches and migraines
 Chronic trunk and limb pain
 Repetitive motion pain
 Arthritis
 Fibromyalgia
 Complex regional pain
 Cancer pain
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Other criteria for referring patients to pain
specialists
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Multiple symptoms or sources of pain
Unresponsive to conservative therapies
Deteriorated functional status
Uncomfortable prescribing or monitoring opioid
treatment
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Choosing a pain physician for referrals
Verify that the physician is certified by, or a member
of, a pain-related professional organization:
 American Academy of Pain Medicine (AAPM)
 American Board of Pain Medicine (ABPM)
Subspecialty certifications
 American Board of Anesthesiology (ABA)
 American Board of Physical Medicine &
Rehabilitation (ABPMR)
 American Board of Psychiatry & Neurology (ABPN)
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Benefits of referring patients to pain physicians
 Better outcomes for patients
 Enhances effectiveness of primary care treatment
plans
 Improves patient/physician relationships
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Conclusions
 The wide range of treatments available today allows a
patient to receive effective pain relief quickly.
 Cooperation between primary care physicians and
pain management specialists ensures that patients
receive appropriate treatments for their pain.
 An increased understanding of pain helps physicians
improve the quality of life for chronic pain patients.
 Physicians have the power to change the course of
their patients’ lives.
RAISING PAIN AWARENESS
For additional educational
and support information,
please visit
www.ans-medical.com
or
www.NationalPainFoundation.org
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References
1.
2.
3.
4.
5.
Americans Talk about Pain, conducted by Peter D. Hart Research
Associates for Research!America, August 2003.
Pain in America: A Research Report, conducted by the Gallup
Organization for Merck, June 1999.
Voices of Chronic Pain, survey released by the American Pain
Foundation for Endo Pharmaceutical, June 2006.
Stewart, W.F., J.A. Ricci, E. Chee, D. Morganstein, & R. Lipton. “Lost
Productive Time and Cost Due to Common Pain Conditions in the
U.S. Workforce.” Journal of the American Medical Association, Vol.
290, No. 18, 2003, p. 2443-2454.
National Pain Survey, conducted by Louis Harris and Associates for
Ortho-McNeil, 1999.
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References
6.
7.
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Chronic Pain in America: Roadblocks to Relief, conducted by Roper
Starch Worldwide Inc. for the American Pain Society, the American
Academy of Pain Medicine, and Janssen Pharmaceutica, January
1999.
Voices of Chronic Pain, conducted by American Pain Foundation,
May 2006.
“JCAHO Focuses on Pain Management,” Joint Commission on
Accreditation of Healthcare Organizations,
http://www.jcaho.org/news+room/health+care+issues/jcaho+
focuses+on+pain+management.htm.
Stamatos, J., Painbuster: A Breakthrough 4-Step Program for Ending
Chronic Pain, First Edition, New York, NY: Henry Holt & Company,
LLC, 2001.